[Laser CO2 and ocular plastic surgery].
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Blepharoplasty↗
Biomedical subjects
S Morax
Publications and source records attributed to S Morax.
[Orbital decompression in exophthalmos due to thyroid disease. Report of 69 cases].
Dysthyroid exophthalmos is due to mismatching of the orbit and its contents, essentially due to muscle enlargement, and, to a lesser degree, fat volumetric changes. Surgical treatment is designed to expand the orbital volume by bone removal or to reduce orbital contents by fat removal, or a combination of the two techniques. Our series consisted of 69 patients who underwent orbital decompression for proptosis, with osteotomy (12 cases) or associated with fat removal (57 cases). We obtained good results for all cases, and did not encounter any complications. Several factors now appear to play a role in the choice of surgical technique, particularly the preoperative radiologic (CT) examination which determines the muscular and fat involvement, wall orbital changes and appearance of the sinuses. Orbital fat removal seems to be useful in proptosis reduction in those cases in which fat is more involved and easy to remove. Anthral ethmoidal decompression is the best technique in the case of dysthyroid optic neuropathy.
Adult↗
[Primary congenital ectropion. Apropos of 2 cases].
PURPOSE: Congenital lid ectropion is a rare anomaly. In the usual classification, primary ectropion caused by tightening of the anterior lamella may sometimes be confused with secondary ectropion, especially with blepharophimosis syndrome or euryblepharon. METHODS: Through analysis of two representative cases of congenital ectropion and review of literature we discuss similarities and differences between primary and secondary ectropion including blepharophimosis and euryblepharon. RESULTS: Horizontal narrowing of palpebral fissure and inversus epicanthal folds are the main clinical feature to be considered when differential diagnosis is difficult between primary forms and blepharophimosis, as ptosis is often an underlying abnormaly in both cases. CONCLUSION: To be effective, the surgical management of congenital lid ectropion requires precise clinical examination, clear understanding of causative factors and several procedures.
Blepharophimosis↗
[Colobomatous cyst of the orbit in congenital microphthalmos].
Colobomatous orbital cyst with microphthalmos is an anomaly of the orbital contents occurring during embryogenesis. In this study, we report the case of a 3 year-old child referred with the initial diagnosis of voluminous orbital angioma. Radiological investigations and histological study of the ablated mass established the correct diagnosis of colobomatous cyst. Pathogeny, diagnostic and therapeutic problems are discussed.
Child, Preschool↗
[Surgery of post-traumatic ptosis].
Post-traumatic ptosis may be classified as follows: ptosis occurring during lid avulsion, ptosis associated with fractures of the orbital roof and with foreign bodies, post-contusional ptosis, cicatricial ptosis, neurogenic ptosis and post-surgical ptosis. The patient must be thoroughly examined, including examination of the eye-ball, extra-ocular muscles, eyelid and evaluation of upper eyelid levator function and orbital and facial examination. The various surgical methods proposed include levator muscle surgery, aponeurotic surgery, Müller's muscle surgery and frontalis suspension surgery. Surgical indications and choice of surgical method essentially depend on the anatomo-clinical forms. The general rule is to operate under local anesthesia to obtain better control of the muscular function. Some cases are simple to treat such as post-contusional ptosis with good levator function which allows functional surgery with excellent static and dynamic results. Other relatively simple cases with non functional levators may only be treated on a static basis. Last but not least are more difficult cases in which levator function is difficult to evaluate pre-operatively because of severe fibrosis. The aim in such cases is to explore the eyelid by an anterior approach under local anesthesia and to propose either muscular surgery or a frontalis suspension according to the anatomical and functional status of the levator muscle.
Blepharoptosis↗
[Immature palpebral capillary angioma. A case commented on].
A three-year-old girl presented a voluminous capillary haemangioma associated with amblyopia. This case failed to respond to steroid treatment. Surgical treatment was necessary. The authors describe evolution, complications and therapeutic management of eyelid angiodysplasia.
Child, Preschool↗
[Bovine heterologous bone graft in orbital surgery].
Lubboc (T650) is a bovine heterologous bone implant obtained by specific preparation of trabecular of bone. In vitro and in vivo biocompatibility studies have revealed the absence of any cytotoxicity or systemic toxicity. Lubboc has many fields of application, including all bone graft surgical indications. We report our first results concerning the use of this product in orbital surgery either as a filling or contention material or as an apposition material. On all 20 operated patients we did not encounter any intolerance, inflammation or infection. The follow-up is still too short to appreciate the long term integration of this material which has the advantage of being a substitute for autologous bone, avoiding bone graft harvesting.
Adolescent↗
[Keratoplasty and explantation of the anterior chamber followed by implantation sutured to the sclera].
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Corneal Transplantation↗
[Surgical treatment of myopathic ptosis. Apropos of 20 surgically treated cases].
Twenty cases of severe progressive ophthalmoplegia (Myopathic ptosis) with significant ptosis were treated by various procedures, including levator resection with blepharoplasty or frontalis suspension using temporalis fascia. Surgical indications were generally limited to cases with poor or absent levator function. The results are analysed after an average follow-up of 6 months. The particular problems concerning surgery of myopathic ptosis are discussed.
Blepharoptosis↗
Orbito-palpebral reconstruction in anophthalmos and severe congenital microphthalmos.
In patients with congenital anophthalmos and severe microphthalmos, a tiny orbit and socket exist with little eyelids, frequently preventing retention of a standard conformer or prosthesis. Socket expansion is sometimes impossible with microorbitism; the retention of a prosthesis is also difficult when malformations of the eyelids exist. The treatment of these difficult cases includes three stages. The first stage is orbital expansion that depends on the cephalometric studies of the patient: transverse osteotomy on the maxilla and the zygomatic bone with lateral bar by extracranial route, vertical osteotomy on the roof of the orbit by intracranial route. In some cases, the osteotomy includes expansion in the transverse and vertical diameter with bone grafts in the defects and on the lateral and superior rims. Simultaneously, socket expansion is performed by incision of the conjunctival sac circumferentially, with mucosal or split skin grafts on a conformer. The second stage includes eyelid reconstruction by different flaps. A third stage is frequently needed for correction of eyelid malposition on the prosthesis: ptosis, entropion surgery. Two cases of congenital anophthalmos are reported. Methods and indications of treatment are discussed.
Adolescent↗
Orbito-palpebral reconstruction in two cases of incomplete cryptophthalmos.
Two cases of congenital symblepharon (variant of cryptophthalmos) are reported. Cryptophthalmos is a very rare congenital defect, with incomplete or complete failure in the development of one or both eyelids with skin recovering the anterior segment. Surgical treatment is described including expansion of the conjunctival fornix with eyeball conservation if possible. At the same time or later, the upper eyelid is reconstructed by inferior eyelid flap. The ophthalmic features of cryptophthalmos and its systemic associations are reviewed.
Adult↗
[Orbital lymphangioma. Apropos of 2 uncommon cases].
Lymphangiomas can be considered as hemodinamically isolated vascular hamartomas. They are rare tumors, and their orbito-palpebral location can be cosmetically and functionally detrimental. In severe cases, the treatment is mainly surgical and effective only if complete removal is performed. The result is often deceiving because of the diffuse extension of these tumors. We hereby report two exceptionally severe cases that both presented with major cosmetic impairment and visual loss. We discuss literature available, the management and the methods of treatment and the non-surgical alternatives.
Female↗
[The aging eyelid].
The ocular adnexal tissues share the progressive loss of tone and bulk, common to many aging tissues. As a result of these progressive involutional changes lid anatomy is altered inducing senile ptosis, ectropions, entropions, canthal laxity and epitheliomas. A better understanding of these conditions allows more appropriate surgical management. Senile ptosis is an acquired ptosis usually due to dehiscence or disinsertion of the levator aponeurosis (below the orbital septum); surgery aims to reattach it to the tarsal plate via either anterior or posterior approach. Senile ectropions and entropions share several aetiologic factors: horizontal laxity, lid retractors, laxity migration of the preseptal orbicularis for senile entropion; stretching of the canthal tendons, secondary skin retraction and conjunctival thickening for senile ectropion. The entropion requires the association of horizontal lid shortening, lower eyelid retractors shortening, skin blepharoplasty with deep sutures (between preseptal and pretarsal orbicularis). In some cases of senile ectropions, the horizontal shortening of the eyelid by a full-thickness pentagon resection with shortening of the lower eyelid retractors must be associated with a medial canthal tendon plication and skin graft.
Aged↗
Use of GORE-TEX (polytetrafluoroethylene) in the anophthalmic socket.
The GORE-TEX soft tissue patch is composed of large open spaces surrounded by polytetrafluoroethylene (PTFE) fibers connected to nodules of solid PTFE. It was used in 12 oculoplastic surgery patients. Primary and secondary spherical silicone implants were wrapped with a GORE-TEX patch and implanted into Tenon's capsule. This study reports our first results using this versatile material.
Humans↗
[Choice of treatment in surgery of congenital ptosis].
Because of the great variety of congenital ptosis and surgical procedures, the choice of a definite surgical protocol is rather difficult. The author reports here three surgical techniques which have been used for over 5 years. The levator muscle resection with upper lid fold reconstruction via a skin approach is still the preferred technique in most cases. The main problem is to determine the magnitude of muscle resection which is directly related to the levator function. Frontalis suspension with autogenous fascia-lata or synthetic materials as Goretex is performed in case of levator resection failure: non-functioning muscle, muscular dysfunction as in the Marcus Gunn syndrome. The conjunctiva-Müller's muscle excision avoiding overcorrection is indicated in cases of minor congenital ptosis with good muscular function and positive response to topical 10% epinephrine drops.
Blepharoptosis↗
The management of congenital malpositions of eyelids, eyes and orbits.
Congenital malformations of the eye and its adnexa which are multiple and varied can affect the whole eyeball or any part of it, as well as the orbit, eyelids, lacrimal ducts, extra-ocular muscles and conjunctiva. A classification of these malformations is presented together with the general principles of treatment, age of operating and surgical tactics. The authors give some examples of the anatomo-clinical forms, eyelid malformations such as entropion, ectropion, ptosis, levator eyelid retraction, medial canthus malposition, congenital eyelid colobomas, and congenital orbital abnormalities (Craniofacial stenosis, orbital plagiocephalies, hypertelorism, anophthalmos, microphthalmos and cryptophthalmos).
Eye Abnormalities↗
The surgical management of orbitopalpebral neurofibromatosis.
Orbitopalpebral neurofibromatosis may cause severe soft tissue deformity. Exophthalmos is either due to an intraorbital mass or to the absence of the greater wing of the sphenoid (mesodermal dysplasia). Five patients are presented. Surgical procedures and craniofacial techniques are detailed and discussed.
Adolescent↗